Provider Demographics
NPI:1316172588
Name:TW PONESSA & ASSOCIATES COUNSELING SERVICES
Entity type:Organization
Organization Name:TW PONESSA & ASSOCIATES COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-560-7917
Mailing Address - Street 1:2141 OREGON PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4604
Mailing Address - Country:US
Mailing Address - Phone:717-560-7917
Mailing Address - Fax:
Practice Address - Street 1:2141 OREGON PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4604
Practice Address - Country:US
Practice Address - Phone:717-560-7917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW123702104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty